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What does this mean I cannot find it anywhere

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13 comments

  • Official comment
    Dustin

    Hi Linda,

    I see that the rejection for this secondary claim: https://secure.simplepractice.com/clients/ec4ebf80549fe6a0/insurance_claims/41804797 was caused by the presence of a primary claim adjudication date in the code that was sent with the secondary claim. If you're looking at the rejected secondary claim (link above), when you scroll down to the bottom, you'll see that under EOB Information from Primary Claim there's an "Adjudication date: 2019-01-18"

    In the accepted status data for the primary claim, the effective date was listed as 2019-01-18 which was then added to the secondary claim's code. There is currently no way to simply remove the primary adjudication date before sending the secondary claim as it is automatically populated from the primary claim payment report data that we received from our clearinghouse.

    To have this claim processed by the payer without being rejected by the third party clearinghouse or the payer, our clearinghouse recommends resubmitting the claim as an original secondary claim without the primary claim adjudication date. To do this, you'll have to "detach" the accepted status data from the primary claim before creating the secondary claim. Please see the steps below;

    1) Delete the rejected secondary claim:https://secure.simplepractice.com/clients/ec4ebf80549fe6a0/insurance_claims/41804797 

    2) Delete the primary claim as well: https://secure.simplepractice.com/clients/ec4ebf80549fe6a0/insurance_claims/39192907 This will detach the adjudication date data from the primary claim. I recommend downloading a copy of the original primary claim first to store for your records in case there's any issue of timely filing, as downloaded claims are timestamped.

    3) Create a new primary claim. This will be marked Paid by the insurance payment that will still be in the account, though you may need to refresh the page or wait a few minutes for the system to process.

    4) After the primary claim's status updates to Paid, the Create Secondary Claim button will appear at the top. Once that appears, please create and submit a new secondary claim.

    You will only need to follow these steps when the primary claim has been assigned a Payer Claim # before you submit the secondary claim. To make this a scalable workflow for submitting secondary claims, I recommend submitting the secondary claim before the primary claim's payment report is entered into our system. This way, you won't have to worry about the adjudication date being attached to the secondary claim. Perhaps you can use past data to manually fill box 29 of the secondary claim with the amount that primary usually pays.

    Please give this a try and let me know if you run into any further trouble. I'm here to help.

    Best,

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  • Mandi Waite

    I am dealing with this same problem. I followed the instructions you  listed above and the claim is not updating to say PAID. I've waited for quite a while and refreshed several times, even signed in and out. Is there something missing? Does it take a long time? 

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  • Dustin

    Hi Mandi,

    I'm having trouble locating your account but I'd like to take a look at the claim you're referring to. Could you write in to the Help Center by clicking the orange Help button in the lower left corner of the SimplePractice account? This way we can work with you in the account to see what preventing the claim status from updating. Thank you.

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  • Mandi Waite

    Hi there, I gave it a day and went back and it updated, it just took a long time. Thanks! 

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  • Dustin Alipour, LCSW

    Excellent. Thank you for letting us know. 

    Best wishes, Mandi. 

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  • Susan Mason

    I submitted a claim for a client who I have processed before successfully. This says there is more information from the provider needed. I don't know what information or how to begin to determine how to provide that. Please help!

    Thanks,

    Susan M

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  • Lisa Smalheiser

    Dustin, can you help me with mine, as well? I am getting the same error message above

     

    Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. (A3) Missing or invalid information. DATE OR TIME OR PERIOD (CLAIM CHECK OR REMITTANCE DATE) IS USED. IT SHOULD NOT BE USED WHEN MONETARY AMOUNT INFORMATION (COORDINATION OF BENEFITS (COB) TOTAL NON-COVERED AMOUNT) IS USED. DATE OR TIME OR PERIOD IS DEFINED IN THE GUIDELINE AT POSITION 3500. (21)

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  • Linda Reid

    I have tried this and it does work to a point but it is a lot of unnecessary work.  Now I have client accounts that want invoicing and primary claims submissions for the claims that have been deleted.  I cannot seem to get them out of my batching.   I may just print and send via snail mail.   Totally worth the stamp and waiting period.

     

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  • Dustin

    Hi Linda and Susan, 

    These questions would be best addressed by the personal support you can receive by writing in to our support team. Please create a Help Request from you SimplePractice account and one of my teammates will be happy to investigate this further with you. Thank you so much for your understanding. 

    P.S. Thank you for submitting a request Lisa.

    Best,

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  • Marcia Kennedy

    I tried these steps and they did not work to prompt the creation of a secondary claim. I saved the original to my computer then deleted it to make a new original. It did not give me a Create SEcondary Claim button. Now all I have is another original to send to the same insurance company that denied payment becuase the original claim went straight to the client's deductible. I am not able to submit a secondary claim. 

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  • Gillian

    Hi Marcia, because this is specific to your account, it's great that you've reached out to our team via email for assistance. We'll be in touch shortly. 

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  • Marcia Kennedy

    I thought this situation was fixed but the secondary claim kicked back to me as Rejected for the same reason. I followed the directions to get this resolved and it did not work. 

    https://secure.simplepractice.com/clients/bdb30546c32346be/insurance_claims/65143604

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  • Ayelette

    Hi Marcia,

    We'd be happy to help with this. Because this is specific to your account, I’ve created a help request on your behalf so that a member of our Success team can investigate this for you further. They’ll be reaching out to you with more information over email.

    For future reference, the quickest way to get support for account-specific questions is to send us a help request by clicking the blue question mark icon on the lower right of your SimplePractice account > clicking Get Help. For more details, feel free to check out this Help Center guide: Logging in to SimplePractice and submitting help requests.

    Although we're periodically monitoring the Community Forum, this is also a place for customers to exchange ideas and engage with one another on how to best use our platform. Thank you for acting as resources for each other in the meantime.

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